Idiopathic Hypersomnia: Recognition and Management in Psychiatric Practice

Objective: This review of the relationship between idiopathic hypersomnia and psychiatric disorders describes considerations in recognizing and managing complaints of excessive daytime sleepiness (EDS) in patients in psychiatric clinical practice. Data Sources: Terms including "idiopathic hypersomnia" and "psychiatric" were used to search PubMed and Embase for English-language publications of human studies from inception to July 2024. Study Selection: Articles were manually screened for relevance to idiopathic hypersomnia pathophysiology, diagnosis, and treatment and EDS in psychiatric populations. Reference lists of identified articles were manually searched for additional relevant publications. Data Extraction: Formal data charting was not performed. Results: A total of 119 articles were included. Idiopathic hypersomnia is a central sleep disorder with the primary complaint of EDS, diagnosed prevalence of 0.037%, and estimated population prevalence up to 1.5%. Other prominent symptoms include sleep inertia, long sleep time, autonomic nervous system dysfunction, brain fog, and cognitive complaints. A high proportion of patients with idiopathic hypersomnia experience psychiatric comorbidities, including mood disorders and attention-deficit/ hyperactivity disorder. Assessing individuals with psychiatric disorders and complaints of hypersomnolence can pose diagnostic challenges. Diagnosis and treatment may be complicated by possible exacerbation of EDS by psychiatric medications and, conversely, exacerbation of psychiatric symptoms by idiopathic hypersomnia treatments. Conclusions: Psychiatric clinicians are more likely to encounter patients with idiopathic hypersomnia than would be expected given its overall prevalence due to increased rate of psychiatric symptom comorbidity in this population. Recognizing and managing idiopathic hypersomnia for individuals with psychiatric conditions may lead to improvements in treatment outcome for patients.